Gamma-emitting radionuclide ^(99m)Tc is globally used for the diagnosis of various pathological conditions owing to its ideal single-photon emission computed tomography (SPECT) characteristics.However,the short half-l...Gamma-emitting radionuclide ^(99m)Tc is globally used for the diagnosis of various pathological conditions owing to its ideal single-photon emission computed tomography (SPECT) characteristics.However,the short half-life of ^(99m)Tc (T_(1/2)=6 h)makes it difficult to store or transport.Thus,the production of ^(99m)Tc is tied to its parent radionuclide ^(99)Mo (T_(1/2)=66 h).The major production paths are based on accelerators and research reactors.The reactor process presents the potential for nuclear proliferation owing to its use of highly enriched uranium (HEU).Accelerator-based methods tend to use deuterium–tritium(D–T) neutron sources but are hindered by the high cost of tritium and its challenging operation.In this study,a new ^(99)Mo production design was developed based on a deuterium–deuterium (D–D) gas dynamic trap fusion neutron source (GDT-FNS) and a subcritical blanket system (SBS) assembly with a low-enriched uranium (LEU) solution.GDT-FNS can provide a relatively high-neutron intensity,which is one of the advantages of ^(99)Mo production.We provide a Monte Carlo-based neutronics analysis covering the calculation of the subcritical multiplication factor (k_(s)) of the SBS,optimization design for the reflector,shielding layer,and ^(99)Mo production capacity.Other calculations,including the neutron flux and nuclear heating distributions,are also provided for an overall evaluation of the production system.The results demonstrated that the SBS meets the nuclear critical safety design requirement (k_(s)<0.97) and maintained a high ^(99)Mo production capacity.The proposed system can generate approximately 157 Ci ^(99)Mo for a stable 24 h operation with a neutron intensity of 1×10^(14) n/s,which can meet 50%of China’s demand in 2025.展开更多
In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal androgen blockade （MAB） versus castration alone in Chinese patients with advanced prostate cancer. From 1996 to 2004, 608...In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal androgen blockade （MAB） versus castration alone in Chinese patients with advanced prostate cancer. From 1996 to 2004, 608 patients with advanced prostate cancer were included in the study. Patients were retrospectively divided into two groups according to different therapeutic regimens. Of the 608 patients, 300 patients were treated with MAB （castration plus nonsteroidal antiandrogens） and the remaining 308 were treated with castration alone. The 2- and 5-year overall survival rates of these patients were 73.7% and 56%, respectively. Multivariate analysis showed that, in patients with metastatic prostate cancer, MAB was associated with not only the improvement of progression-free survival （PFS） （increased by 10 months） but also a 20.6% reduction in mortality risk compared with castration alone. In contrast, the efficacy of MAB was not superior to castration alone for patients with nonmetastatic prostate cancer. Interestingly, among patients with MAB, those using bicalutamide had a longer PFS than those using flutamide; this was especially so in patients with metastatic prostate cancer. Almost all of the toxicities due to the hormone therapy were mild to moderate and manageable. To conclude, in China, hormone therapies, including MAB and castration alone, have been standard treatments for advanced prostate cancer. For patients with nonmetastatic prostate cancer, castration alone might be adequately practical and efficient. In patients with metastatic prostate cancer, however, MAB has superior efficacy over castration alone. It is clear that MAB should be considered the first-line standard treatment for patients with metastatic prostate cancer.展开更多
The present study investigated the effects of the multikinase inhibitor sorafenib on androgen-independent can- cer cells viability and intracellular signaling. Human androgen-independent PC-3 prostate cancer cells wer...The present study investigated the effects of the multikinase inhibitor sorafenib on androgen-independent can- cer cells viability and intracellular signaling. Human androgen-independent PC-3 prostate cancer cells were treated with sorafenib. At concentration that suppresses extracellular signal-regulated kinase phosphorylation, sorafenib treatment reduced the mitochondrial transmembrane potential. Sorafenib also down-modulated the levels of mye- loid cell leukemia 1, survivin and cellular inhibitor of apoptosis protein 2. Sorafenib induced caspase-3 cleavage and the mitochondrial release of cytochrome c. However, no nuclear translocation of apoptosis inducing factor was detected after treatment and the pan-caspase inhibitor Z-VAD-FMK had an obvious protective effect against the drug. In conclusion, sorafenib induces apoptosis through a caspase-dependent mechanism with down-regulated antiapoptotic proteins in androgen-independent prostate cancer cells in vitro.展开更多
The concept of intraductal carcinoma of prostate （IDC-P） has evolved over the years and its clinieopathologic significance has come to be more clearly appreciated. In contrast to morphologically malignant intraducta...The concept of intraductal carcinoma of prostate （IDC-P） has evolved over the years and its clinieopathologic significance has come to be more clearly appreciated. In contrast to morphologically malignant intraductal lesions that represent earlier stages of the malignant process in other anatomic sites such as the breast, IDC-P has now been generally recognized as a prognostically unfavorable manifestation of later stage spreading of its invasive counterpart. We here briefly review the evolution of the IDC-P concept, the histological diagnostic criteria and differential diagnosis, the clinical significance, as well as recent molecular data of IDC-P.展开更多
BACKGROUND Fulminant lupus myocarditis is a rare but fatal manifestation of systemic lupus erythematosus.Aggressive immunosuppressive treatments are important in its successful management.However,they can significantl...BACKGROUND Fulminant lupus myocarditis is a rare but fatal manifestation of systemic lupus erythematosus.Aggressive immunosuppressive treatments are important in its successful management.However,they can significantly damage the immunity and are associated with a considerable risk of infection development and spread.We present a rare and complicated case of a 20-year-old female diagnosed with fulminant lupus myocarditis accompanied by pneumonia.The patient was successfully treated with plasma exchange(PE)for fulminant lupus myocarditis.CASE SUMMARY A 20-year-old Chinese woman presented to the Hematology Department complaining of fatigue and knee pain.Blood test showed anemia and thrombocytopenia.On the second day of hospitalization,she was transferred to the ICU due to dyspnea and hypotension.Autoimmune profiles showed hypocomplementemia and positive antinuclear antibodies.Computer tomography showed an enlarged heart and pneumonia.Ultrasound revealed an enlarged heart with a low left ventricular ejection fraction.Fulminant lupus myocarditis with cardiogenic shock was initially considered.Due to the accompanying pneumonia,aggressive immunosuppression was contraindicated.Her cardiac function remained critical after the initial therapy of intravenous immunoglobulin and corticosteroids at a conventional dose,but she responded well to later PE therapy plus corticosteroids administration.The patient fully recovered with normal cardiac function.CONCLUSION This case indicates that PE is a valuable treatment choice without adverse effects of immunosuppression in patients with fulminant lupus myocarditis and coexisting infection.展开更多
BACKGROUND Pacemaker lead-induced heart perforation is a rare but life-threatening complication of pacemaker implantation,and timely diagnosis remains a challenge for clinicians.Here,we report a case of pacemaker lead...BACKGROUND Pacemaker lead-induced heart perforation is a rare but life-threatening complication of pacemaker implantation,and timely diagnosis remains a challenge for clinicians.Here,we report a case of pacemaker lead-induced cardiac perforation rapidly diagnosed by a“bow-and-arrow”sign on point-of-care ultrasound(POCUS).CASE SUMMARY A 74-year-old Chinese woman who had undergone permanent pacemaker implantation 26 d before suddenly developed severe dyspnea,chest pain,and hypotension.The patient had received emergency laparotomy for an incarcerated groin hernia and was transferred to the intensive care unit 6 d before.Computed tomography was not available due to unstable hemodynamic status,so POCUS was performed at the bedside and revealed severe pericardial effusion and cardiac tamponade.Subsequent pericardiocentesis yielded a large volume of bloody pericardial fluid.Further POCUS by an ultrasonographist revealed a unique“bow-and-arrow”sign indicating right ventricular(RV)apex perforation by the pacemaker lead,which facilitated the rapid diagnosis of lead perforation.Given the persistent drainage of pericardial bleeding,urgent off-pump open chest surgery was performed to repair the perforation.However,the patient died of shock and multiple organ dysfunction syndrome within 24 h post-surgery.In addition,we also performed a literature review on the sonographic features of RV apex perforation by lead.CONCLUSION POCUS enables the early diagnosis of pacemaker lead perforation at the bedside.A step-wise ultrasonographic approach and the“bow-and-arrow”sign on POCUS are helpful for rapid diagnosis of lead perforation.展开更多
BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced...BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.展开更多
Despite the recent progress of medical technology in the diagnosis and treatment of tumors,pancreatic carcinoma remains one of the most malignant tumors,with extremely poor prognosis partly due to the difficulty in ea...Despite the recent progress of medical technology in the diagnosis and treatment of tumors,pancreatic carcinoma remains one of the most malignant tumors,with extremely poor prognosis partly due to the difficulty in early and accurate imaging evaluation.This paper focuses on the research progress of magnetic resonance imaging,nuclear medicine molecular imaging and radiomics in the diagnosis of pancreatic carcinoma.We also briefly described the achievements of our team in this field,to facilitate future research and explore new technologies to optimize diagnosis of pancreatic carcinoma.展开更多
BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or ...BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.展开更多
基金supported by Anhui Provincial Key R&D Program (202104g0102007)Hefei Municipal Natural Science Foundation (2022011)+2 种基金Collaborative Innovation Program of Hefei Science CenterChinese Academy of Sciences(2022HSC CIP024)International Partnership Program of Chinese Academy of Sciences (116134KYSB20200001)。
文摘Gamma-emitting radionuclide ^(99m)Tc is globally used for the diagnosis of various pathological conditions owing to its ideal single-photon emission computed tomography (SPECT) characteristics.However,the short half-life of ^(99m)Tc (T_(1/2)=6 h)makes it difficult to store or transport.Thus,the production of ^(99m)Tc is tied to its parent radionuclide ^(99)Mo (T_(1/2)=66 h).The major production paths are based on accelerators and research reactors.The reactor process presents the potential for nuclear proliferation owing to its use of highly enriched uranium (HEU).Accelerator-based methods tend to use deuterium–tritium(D–T) neutron sources but are hindered by the high cost of tritium and its challenging operation.In this study,a new ^(99)Mo production design was developed based on a deuterium–deuterium (D–D) gas dynamic trap fusion neutron source (GDT-FNS) and a subcritical blanket system (SBS) assembly with a low-enriched uranium (LEU) solution.GDT-FNS can provide a relatively high-neutron intensity,which is one of the advantages of ^(99)Mo production.We provide a Monte Carlo-based neutronics analysis covering the calculation of the subcritical multiplication factor (k_(s)) of the SBS,optimization design for the reflector,shielding layer,and ^(99)Mo production capacity.Other calculations,including the neutron flux and nuclear heating distributions,are also provided for an overall evaluation of the production system.The results demonstrated that the SBS meets the nuclear critical safety design requirement (k_(s)<0.97) and maintained a high ^(99)Mo production capacity.The proposed system can generate approximately 157 Ci ^(99)Mo for a stable 24 h operation with a neutron intensity of 1×10^(14) n/s,which can meet 50%of China’s demand in 2025.
基金Acknowledgment We thank Professor Qiao Zhou from the Department of Pathology, West China Hospital, Dr Jing Gong from the Laboratory of Pathology, the State Key Laboratory of Biotherapy, and many other clinicians from the Department of Urology, West China hospital for their kind assistance. This work was supported by the National Natural Science Foundation of China （No. NSFC30700977, No. NSFC30800637 and No. NSFC30871383）.
文摘In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal androgen blockade （MAB） versus castration alone in Chinese patients with advanced prostate cancer. From 1996 to 2004, 608 patients with advanced prostate cancer were included in the study. Patients were retrospectively divided into two groups according to different therapeutic regimens. Of the 608 patients, 300 patients were treated with MAB （castration plus nonsteroidal antiandrogens） and the remaining 308 were treated with castration alone. The 2- and 5-year overall survival rates of these patients were 73.7% and 56%, respectively. Multivariate analysis showed that, in patients with metastatic prostate cancer, MAB was associated with not only the improvement of progression-free survival （PFS） （increased by 10 months） but also a 20.6% reduction in mortality risk compared with castration alone. In contrast, the efficacy of MAB was not superior to castration alone for patients with nonmetastatic prostate cancer. Interestingly, among patients with MAB, those using bicalutamide had a longer PFS than those using flutamide; this was especially so in patients with metastatic prostate cancer. Almost all of the toxicities due to the hormone therapy were mild to moderate and manageable. To conclude, in China, hormone therapies, including MAB and castration alone, have been standard treatments for advanced prostate cancer. For patients with nonmetastatic prostate cancer, castration alone might be adequately practical and efficient. In patients with metastatic prostate cancer, however, MAB has superior efficacy over castration alone. It is clear that MAB should be considered the first-line standard treatment for patients with metastatic prostate cancer.
基金We thank Mr Wen-Tong Meng and Mr Ji-Long Gou （Stem Cell Research Laboratory, West China Hospital, Sichuan University, Chengdu, China） for technical assistance with the flow cytometry. We also thank BioMed Proofreading for their editing work. This work was supported by grants to Prof. Hao Zeng and Dr Rui Huang from the National Natural Science Foundation of China （NSFC 30700977 and 30600153）.
文摘The present study investigated the effects of the multikinase inhibitor sorafenib on androgen-independent can- cer cells viability and intracellular signaling. Human androgen-independent PC-3 prostate cancer cells were treated with sorafenib. At concentration that suppresses extracellular signal-regulated kinase phosphorylation, sorafenib treatment reduced the mitochondrial transmembrane potential. Sorafenib also down-modulated the levels of mye- loid cell leukemia 1, survivin and cellular inhibitor of apoptosis protein 2. Sorafenib induced caspase-3 cleavage and the mitochondrial release of cytochrome c. However, no nuclear translocation of apoptosis inducing factor was detected after treatment and the pan-caspase inhibitor Z-VAD-FMK had an obvious protective effect against the drug. In conclusion, sorafenib induces apoptosis through a caspase-dependent mechanism with down-regulated antiapoptotic proteins in androgen-independent prostate cancer cells in vitro.
基金supported by grants from the Natural Science Foundation of China (NSFC 81272848, 81272820, 81302225, 81572540)
文摘The concept of intraductal carcinoma of prostate （IDC-P） has evolved over the years and its clinieopathologic significance has come to be more clearly appreciated. In contrast to morphologically malignant intraductal lesions that represent earlier stages of the malignant process in other anatomic sites such as the breast, IDC-P has now been generally recognized as a prognostically unfavorable manifestation of later stage spreading of its invasive counterpart. We here briefly review the evolution of the IDC-P concept, the histological diagnostic criteria and differential diagnosis, the clinical significance, as well as recent molecular data of IDC-P.
文摘BACKGROUND Fulminant lupus myocarditis is a rare but fatal manifestation of systemic lupus erythematosus.Aggressive immunosuppressive treatments are important in its successful management.However,they can significantly damage the immunity and are associated with a considerable risk of infection development and spread.We present a rare and complicated case of a 20-year-old female diagnosed with fulminant lupus myocarditis accompanied by pneumonia.The patient was successfully treated with plasma exchange(PE)for fulminant lupus myocarditis.CASE SUMMARY A 20-year-old Chinese woman presented to the Hematology Department complaining of fatigue and knee pain.Blood test showed anemia and thrombocytopenia.On the second day of hospitalization,she was transferred to the ICU due to dyspnea and hypotension.Autoimmune profiles showed hypocomplementemia and positive antinuclear antibodies.Computer tomography showed an enlarged heart and pneumonia.Ultrasound revealed an enlarged heart with a low left ventricular ejection fraction.Fulminant lupus myocarditis with cardiogenic shock was initially considered.Due to the accompanying pneumonia,aggressive immunosuppression was contraindicated.Her cardiac function remained critical after the initial therapy of intravenous immunoglobulin and corticosteroids at a conventional dose,but she responded well to later PE therapy plus corticosteroids administration.The patient fully recovered with normal cardiac function.CONCLUSION This case indicates that PE is a valuable treatment choice without adverse effects of immunosuppression in patients with fulminant lupus myocarditis and coexisting infection.
基金Supported by Foundation of Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN 179National Natural Science Foundation of China,No.82160370Guizhou Education Department,No.Qian Jiao He KY Zi[2018]239.
文摘BACKGROUND Pacemaker lead-induced heart perforation is a rare but life-threatening complication of pacemaker implantation,and timely diagnosis remains a challenge for clinicians.Here,we report a case of pacemaker lead-induced cardiac perforation rapidly diagnosed by a“bow-and-arrow”sign on point-of-care ultrasound(POCUS).CASE SUMMARY A 74-year-old Chinese woman who had undergone permanent pacemaker implantation 26 d before suddenly developed severe dyspnea,chest pain,and hypotension.The patient had received emergency laparotomy for an incarcerated groin hernia and was transferred to the intensive care unit 6 d before.Computed tomography was not available due to unstable hemodynamic status,so POCUS was performed at the bedside and revealed severe pericardial effusion and cardiac tamponade.Subsequent pericardiocentesis yielded a large volume of bloody pericardial fluid.Further POCUS by an ultrasonographist revealed a unique“bow-and-arrow”sign indicating right ventricular(RV)apex perforation by the pacemaker lead,which facilitated the rapid diagnosis of lead perforation.Given the persistent drainage of pericardial bleeding,urgent off-pump open chest surgery was performed to repair the perforation.However,the patient died of shock and multiple organ dysfunction syndrome within 24 h post-surgery.In addition,we also performed a literature review on the sonographic features of RV apex perforation by lead.CONCLUSION POCUS enables the early diagnosis of pacemaker lead perforation at the bedside.A step-wise ultrasonographic approach and the“bow-and-arrow”sign on POCUS are helpful for rapid diagnosis of lead perforation.
基金Supported by Foundation of Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN179Foundation of Kweichow Moutai Hospital,No.MTyk2022-12+1 种基金Foundation of Department of Health of Guizhou Province,No.gzwkj2021-036Guizhou Education Department,No.QIANJIAOHEKYZI[2018]239.
文摘BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.
基金Supported by The Basic and Clinical Cooperative Research Promotion Plan of Anhui Medical University,No.2019xkjT011Anhui Provincial Natural Science Foundation,No.2008085QH406Anhui Medical University Joint Project of Nuclear Medicine and Radiation Medicine,No.2021 Lcxk035.
文摘Despite the recent progress of medical technology in the diagnosis and treatment of tumors,pancreatic carcinoma remains one of the most malignant tumors,with extremely poor prognosis partly due to the difficulty in early and accurate imaging evaluation.This paper focuses on the research progress of magnetic resonance imaging,nuclear medicine molecular imaging and radiomics in the diagnosis of pancreatic carcinoma.We also briefly described the achievements of our team in this field,to facilitate future research and explore new technologies to optimize diagnosis of pancreatic carcinoma.
基金Supported by Guizhou Provincial Health Commission Science and Technology Department,No.GZWKJ2023-009Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN179Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN087.
文摘BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.
